Success in managing diabetes largely depends on being an informed patient, as we hear from Jean Kostak, a certified diabetes care and education specialist at UConn Health. We’re also joined by Martina Sinopoli, who as a fourth-year UConn medical student developed, as her Capstone project, a nutrition and recipe website that UConn Health’s diabetes education program uses as one of its resources for patients. Martina since has graduated and is training in Harvard’s psychiatry residency program.
(Jean Kostak, Martina Sinopoli, Chris DeFrancesco, July 2020)
Chris: We’ve known about diabetes for a really long time, but in some ways we really haven’t. Today on the pulse, we talk about how education and awareness can go such a long way in managing and even preventing diabetes.
This is the UConn Health Pulse, a podcast to help get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful too.
Thank you for joining us. I’m Chris DeFrancesco. Now to varying degrees, many medical conditions are more manageable when you catch them early. And of course the best treatment is prevention. Type two diabetes is a notorious example of a condition against which the best defense simply may be awareness. Today to discuss that as Jean Kostak, a registered dietician and certified diabetes educator at UConn Health, and soon-to-be Dr. Martina Sinopoli, who, as UConn medical student, already is contributing to the wellness of patients. Thank you both for joining me today.
Jean: Thank you for having us.
Martina: Thank you so much for having us.
Chris: Diabetes, Jean, is very common yet very underdiagnosed. Tell us about that.
Jean: Yeah, absolutely. There are about 30 million people in the United States that have diabetes. So that’s a significant number of people, but a number of people don’t even know that they have it. So they’re walking around with diabetes that could be impacting their health and just haven’t gotten to the doctor to get it diagnosed. They’re not exhibiting or feeling any symptoms from the diabetes, and so they just don’t know that they have it. And sometimes they are admitted in the hospital for something else, and then it gets diagnosed and they’re like, “I didn’t know I had diabetes.” So it is very important that people understand what the symptoms are, recognize them as diabetes, and want to get diagnosed or at least talk to their doctor about it.
Martina: Yeah, and I, even in my limited clinical experience, recently saw a patient and we had ordered blood work for her to go, but she was honestly kind of just scared to find out so she didn’t follow up. So that’s sometimes an issue for people as well.
Jean: Very common. Absolutely. We have people that do that as well. They know that it’s in their family, which is a risk factor. They may be overweight. They may not be exercising or eating healthy and they just don’t want to know those numbers. However I have to say once they know, and they get educated, how happy they are, that they’re now in control of something that they thought that they wouldn’t be able to control.
Chris: But if you don’t know you have it, it seems like you can live with it, but then something happens later on as a result of the diabetes, right, that causes really big problems down the road, right?
Jean: Yeah. sometimes it goes to the point where they’re starting to get complications from the diabetes. It wasn’t diagnosed, but some of the symptoms may be blurred vision. So they go to the doctor, they maybe needed an eyeglass prescription change. And that’s not really the case. It really is that the diabetes is interfering with their vision, or they may have some tingling numbness in their legs that tends to be peripheral neuropathy. That is a complication from high blood sugar. So they start to feel those, they are uncomfortable,they go to the doctor for that instead of not really thinking they had diabetes.
Chris: Thirty million people with diabetes, a good number of them, not even aware they have it, so may eventually find out they have it. Then we’ve got a whole other group of people I don’t think you’re including in that 30 million, are the prediabetics.
Jean: Correct, and I don’t know all the figures on that, but I think that’s close to it, like 87 million people with prediabetes, meaning that, they have the kind of the precursors to have type two diabetes. They’re probably overweight, not eating healthy, those kinds of lifestyle things that could impact their blood sugars, especially if they’re at risk with the family history piece of it. So what we want to do do with prediabetes is really get out awareness. And we do that through our national diabetes month in November, and then we have an alert day in April. And so our doctors here at UConn Health are excellent with when a patient comes in for their physicals, they’re doing a fasting glucose and they’re doing an A1C, which will tell them where their blood sugars have been. And if it’s elevated, we start the process of prediabetes instruction.
Chris: If it’s hard to tell if you have regular diabetes, I would imagine it’s even harder to tell if you have prediabetes, unless you kind of know what to look for, or maybe what questions to ask.
Jean: Sure, and I think there typically are not symptoms of prediabetes. It’s really a, “Am I at risk?” And I know a number of institutions, hospitals, other industries, they do health screenings for their employees, and that’s tends to be when the prediabetes gets picked up, if not at somebody’s usual exam. But no, there’s not typically any symptoms. So my speech, if you will, to my patients that come in, I tell them, particularly the newly diagnosed, you have diabetes, spread the word to your family, your kids, your siblings, and let them know so that they can get tested because they are at risk. Maybe they have prediabetes and they can, kind of prevent or delay the onset of type two diabetes with making some lifestyle changes.
Chris: Excellent. Now, we have two types of diabetes. I think a lot of what we’ve talked about was the type two or what we call adult onset. And those are the ones that can be, those are the cases that can be a lot more influenced by, by lifestyle and choices, right?
Chris: There’s still a genetic component to that though, right?
Chris: But then there’s the juvenile diabetes, which is the type one, correct?
Jean: Correct. Typically, we used to call it juvenile diabetes, it’s still called that in some circumstances. But it’s typically diagnosed when people are young, typically under the age of 40, but most people are diagnosed type one, before they’re 20 years old. But we do see some older ones being diagnosed. And what type one diabetes is, is an autoimmune disease where the body’s own cells are being attacked. The ones that make insulin are being attacked by our own bodies and cannot make insulin, and so insulin needs to be injected.
Chris: There’s so much of this, I think can be benefited by just the patient, or maybe before he or she becomes an actual patient with diabetes, but just people having awareness of what to look for, smart, healthy choices to make that can maybe stave it off. And that’s where a diabetes educator can really come in to help. Because what we don’t know can hurt us.
Jean: Absolutely, there’s been some studies that say that once the person is diagnosed with diabetes, if they get diabetes education within the first five years of that diagnosis, lot less risk for complications down the road.
Chris: And what are some examples of the complications down the road?
Jean: Basically every organ in your body, it affects your eyes, your kidneys, your heart, your, your, nervous system, really important to, kind of recognize. And that’s my role, is to tell them, what are the symptoms of some of those complications and what lab tests should be done? How often should you see your eye doctor, how often should you go to the dentist, how often should you check your feet or go to a podiatrist? So my job is to make sure that they know what the care guidelines are, along with the lifestyle changes. No matter whether it’s type one or type two diabetes, healthy eating and exercise are so important.
Martina: And when sometimes we see people in the hospital who have experienced these complications, it’s, it’s very sad. And lots of times they didn’t know they had diabetes right away, but now these complications are something they have to live with and treat, and it could be very hard for many people.
Chris: That’s probably the worst way to find out you have it right when it gets to that point?
Martina: Yeah, I could imagine.
Jean: When you have diabetes and you don’t have complications or any symptoms that interfere with your daily life, you don’t think of it. You think, “Oh gosh, I’m fine. I’m good.” And, and most people are, they are good. But if those blood sugars keep climbing and those complications occur, then it does impact everything that you do in your life.
Chris: Jean Kostak is a certified diabetes educator at UConn Health, and Martina Sinopoli, you’re a fourth year medical student and you’ve been very quietly, patiently waiting for me to ask you a few questions. We talk about one of the resources the diabetes education program at UConn Health offers to its patients, it actually comes from you, Martina. Tell us a little bit about your involvement here. You’re a fourth year medical student.
Martina: Yes. So, we kind of mentioned the topic a little bit already, which is prediabetes. When I was about 14 years old, I went to the doctor and I was overweight, I wasn’t really exercising and I definitely wasn’t eating right. And they tested me for diabetes, looking at my, I don’t know, even that many years ago, if we checked hemoglobin A1C, it was maybe just the blood sugar. And it turned out that I had prediabetes and I spent a long time or a few years kind of going up and down with my weight. I didn’t know how to take control of it, and I didn’t know how to eat healthy. One thing that I kind of found that worked for me was, to keep eating the same, like comfort foods I loved to keep me happy, but to kind of transform them into recipes that were more conducive to me losing weight and keeping my blood sugar low.
So I ended up losing probably like 60 pounds over a few years. And still, to this day, my blood glucose levels are good. So I guess I don’t really have diabetes anymore, but because of my history with this, it kind of led me into the field of medicine and it leads me to still liking to do diabetes education.
So for fourth-year medical school, I created a project which basically looks at what I just talked about. I’m giving kind of suggestions to patients on how they could change some of their most-loved recipes into healthier versions, so they could still eat what they love while choosing a healthier lifestyle.
Chris: OK. Can you give us a couple of example maybe of a healthier twist on a comfort food that we might be able to take from this?
Martina: Sure. The one I like to give us an example is chicken Parmesan, because I’m American Italian, so that’s a food for me that was kind of big.
Chris: OK, I’m listening.
Martina: So it’s chicken Parmesan, you have chicken. Choosing chicken breast is great because it’s lower in fat. And then usually we would bread the chicken and then fry it. So a few things there that you could adjust: Italian seasonings, if you’re breading with that has a lot of salt in a usually, and it adds a lot of carbohydrates. So if you’re really feeling ambitious, you can maybe say no to the breadcrumbs. or some even have whole wheat panko bread crumbs, which will have a little bit more fiber and it won’t be probably as many carbs as like the thick Italian-seasoned ones. And also the method of frying, deep frying a piece of chicken is going to add a lot of saturated fat. If you just bake that in the oven at a high temperature, it’ll get nice and crispy around. And other ways too is, people use full-fat mozzarella, but you could use 1%. You could use part skim. You could even leave the cheese out. So those are a few things with the chicken that you could do to make it a little bit of a healthier dish.
Chris: Excellent. And now you have a website that, Jean, you give to your patients. Tell me how that all works.
Jean: Sure. Yeah. Martina has done a great job with a website of a number of different recipes and converting them into the healthier versions. And I know she did work with our other dietitian, Linda York, to do some of those things, but Martina was well on her way when she came to us.
And what I like to do is give my patients resources that when they walk out of my office, they have some resources to use when they’re at home, because I can’t be with them 24 hours a day. So I often give them websites. And I now refer to Martina’s website because it’s an excellent resource for that specific thing. It’s always, “what can I eat and how can I eat ?” And that’s the first question everyone asks me that when they walk in, and so this website is really a great way of helping them enjoy foods that they like. I don’t take any foods away. I just tell them how to just like you do, Martina, how to eat healthy and still enjoy the foods that we love.
Martina: Yeah, I think that’s really important. And I was so happy to have such great support from Jean and Linda in the UConn office.
Chris: How did you end up getting involved with Jean and with Linda in our specific diabetes program? You’ve just explained to us that you have a little bit of history and a relationship with diabetes, or at least prediabetes in your case, motivated you to a certain extent to get into medicine. How did you find your way to the diabetes education program?
Martina: I really wanted to create a source of information that people could use outside the office, which you mentioned. When I was seeing my doctor at the time, they were giving me handouts, but nothing really that I could use. So a website was something that I had in mind. I think I reached out to Linda because she taught kind of like a class for us, like an independent class. And so I knew her name and I knew she was dietitian here, so I reached out to her. She connected Jean and I as well, and also an endocrinologist is on the project, Dr. Pooja Luthra, so all four of us kind of work together with that.
Chris: OK, and the name of your website?
Martina: The name of the website is “Small Changes in Diet, Big Changes in Health.”
Chris: All right. And now you have an extended URL, which is your name, Martina Sinopoli, martinasinopoli.wixsite.com/smallchanges. And we’ll put this information in the show notes for you listening. We also have a shortened link, which a Bitly: bit.ly/sinopoli. Does that sound right?
Chris: We got that right? OK, that’s “Small Changes in Diet, Big Changes in Health.”
Martina Sinopoli, a fourth-year medical student at the UConn school of medicine, and Jean Kostak, thank you for joining us.
Jean: Thank you.
Martina: Thank you so much.
Chris: You are a certified diabetes educator and registered dietitian, also for UConn Health. So we appreciate you both joining us today.
And that’s our time for today. For Jean Kostak and Martina Sinopoli, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse.
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